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<p>This study aimed to analyze the temporal dynamics of isolation frequencies and resistance rates among Gram-negative multidrug-resistant organisms across different COVID-19 control phases in over 80 hospitals in Gansu Province, China. We extracted patient demographics and antimicrobial susceptibility testing (AST) results for clinical bacterial isolates collected between September 2018 and September 2023. A three-phase interrupted time-series analysis (ITSA) utilizing segmented linear regression models was employed to evaluate temporal changes in five key Gram-negative species and their corresponding resistant phenotypes across different pandemic control phases. Stratified analyses using Chi-square tests for trend were conducted to assess annual resistance trends across various patient subgroups. Overall, carbapenem-resistant organisms (CROs) did not exhibit consistent significant changes during the COVID-19 pandemic. Specifically, the resistance rate of carbapenem-resistant <i>Pseudomonas aeruginosa</i> (CRPA) showed a downward trend during the pandemic period (<i>P</i> &lt; 0.05). The resistance rate of carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) also showed a downward trend, but the difference did not reach statistical significance (<i>P</i> = 0.053). Notably, the resistance rate of carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) demonstrated a marked downward trend after the pandemic control measures ended (<i>P</i> &lt; 0.001). The resistance rate of third-generation cephalosporin-resistant Enterobacterales remained stable during the pandemic but showed a significant upward trend after the control measures were adjusted (<i>P</i> &lt; 0.05). Stratified analyses revealed that the resistance rates of carbapenem-resistant Enterobacterales (CRE) and third-generation cephalosporin-resistant Enterobacterales (3GCephRE) were significantly higher in the intensive care unit (ICU) compared to other clinical wards. During the COVID-19 control period, resistance rates of various bacteria exhibited different patterns, with some species remaining stable and others showing downward trends. Following the adjustment of control measures, both bacterial counts and resistance rates to third-generation cephalosporins showed upward trends, highlighting the imperative for continuous antimicrobial resistance surveillance. This study provides evidence for optimizing antimicrobial stewardship and hospital infection prevention and control strategies in a regional multi-center healthcare setting in Gansu Province. </p>

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Interrupted time-series analysis of trends in Gram-negative antimicrobial-resistant pathogens across different COVID-19 control phases in Gansu Province, China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Dandan Du,
  • Xiaofang Liang,
  • Yulin Wang,
  • Qianqian Liu,
  • Zhangping Lu,
  • Keke Li,
  • Lianhua Wei

摘要

This study aimed to analyze the temporal dynamics of isolation frequencies and resistance rates among Gram-negative multidrug-resistant organisms across different COVID-19 control phases in over 80 hospitals in Gansu Province, China. We extracted patient demographics and antimicrobial susceptibility testing (AST) results for clinical bacterial isolates collected between September 2018 and September 2023. A three-phase interrupted time-series analysis (ITSA) utilizing segmented linear regression models was employed to evaluate temporal changes in five key Gram-negative species and their corresponding resistant phenotypes across different pandemic control phases. Stratified analyses using Chi-square tests for trend were conducted to assess annual resistance trends across various patient subgroups. Overall, carbapenem-resistant organisms (CROs) did not exhibit consistent significant changes during the COVID-19 pandemic. Specifically, the resistance rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) showed a downward trend during the pandemic period (P < 0.05). The resistance rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) also showed a downward trend, but the difference did not reach statistical significance (P = 0.053). Notably, the resistance rate of carbapenem-resistant Acinetobacter baumannii (CRAB) demonstrated a marked downward trend after the pandemic control measures ended (P < 0.001). The resistance rate of third-generation cephalosporin-resistant Enterobacterales remained stable during the pandemic but showed a significant upward trend after the control measures were adjusted (P < 0.05). Stratified analyses revealed that the resistance rates of carbapenem-resistant Enterobacterales (CRE) and third-generation cephalosporin-resistant Enterobacterales (3GCephRE) were significantly higher in the intensive care unit (ICU) compared to other clinical wards. During the COVID-19 control period, resistance rates of various bacteria exhibited different patterns, with some species remaining stable and others showing downward trends. Following the adjustment of control measures, both bacterial counts and resistance rates to third-generation cephalosporins showed upward trends, highlighting the imperative for continuous antimicrobial resistance surveillance. This study provides evidence for optimizing antimicrobial stewardship and hospital infection prevention and control strategies in a regional multi-center healthcare setting in Gansu Province.